Understanding Angina

Types of Angina

Angina is a term used to describe chest pain or discomfort resulting from decreased blood flow to the heart. This pain can present in different ways for different people. Some may feel a sharp pain or discomfort in the chest, while others might experience a squeezing or tightening sensation.

Typically, the discomfort starts in the centre of the chest, just behind the breastbone, and can radiate to the neck, jaw, shoulders, arms, back, or even the abdomen.

There are two main types of angina: stable and unstable angina.

Stable Angina

Unstable Angina

The most common form of angina.
Generally occurs when the heart has to work harder, such as during physical activity or stress, but does not get enough oxygen-rich blood.
Episodes of chest pain are typically experienced during exertion or stress.
Usually manageable and can be alleviated by resting, taking nitroglycerin, or using a combination of both.
Some individuals with stable angina may eventually develop unstable angina.

Occurs due to reduced blood flow to the heart muscle, often caused by the narrowing of coronary arteries due to fatty deposits known as atherosclerosis.
Occasionally, these fatty plaques can rupture, causing injury to the coronary arteries. This can trigger the formation of blood clots, further blocking blood flow to the heart muscle and leading to episodes of unstable angina.
Dangerous, unpredictable, and can occur without warning, even when a person is at rest.

Angina vs Heart Attack

Angina occurs when the blood flow to the heart muscle is reduced, usually due to narrowed or blocked coronary arteries. In contrast, a heart attack, or myocardial infarction, happens when the blood flow to a section of the heart muscle is severely reduced or completely obstructed, causing damage or death to the heart tissue.

Though angina and heart attacks may present with similar symptoms, they differ significantly in their causes, severity, and treatment methods. Angina often serves as a warning sign of existing heart disease, while a heart attack is a critical medical emergency that requires immediate intervention.

Here are some common triggers that may lead to angina:

Physical exertion: Activities requiring more oxygen for the heart, such as climbing stairs or carrying heavy items.
Exercising right after eating: Engaging in physical activity immediately following a meal can strain the heart.
Emotional stress: Strong emotions like anger, anxiety, or frustration can elevate heart rate and blood pressure.
Extreme temperatures: Exposure to very hot or cold environments can strain the heart, as it has to work harder to regulate body temperature.
Overeating: Consuming large meals can increase the heart’s workload.
Sexual activity: Similar to physical exertion, engaging in sexual activity can elevate heart rate and blood pressure.

Angina Risk Factors

Risk factors for developing angina include underlying health conditions such as diabetes, obesity, high cholesterol levels, hypertension, family history of heart disease, and being 45 years and above for men or being 55 years and above for women.

Lifestyle factors include stress, smoking, sedentary lifestyle, and unhealthy diet.

Angina Symptoms

Angina symptoms can differ from one person to another. Common signs include a tight, heavy, or dull ache in the chest; pain that spreads to the neck, jaw, shoulder, arm, back, or stomach (typically on the left side); shortness of breath; dizziness; nausea; and fatigue.

Chest pain related to angina should always be taken seriously. Seek immediate medical attention if you experience sudden, unexplained chest pain, or if:

Your symptoms last longer than usual.
The intensity of your symptoms is worse than normal.
The frequency of your symptoms has increased.
The chest pain feels different from what you usually experience.
Pain or discomfort persists even when resting or after taking nitroglycerin (after five minutes or three doses).

If you experience an angina attack:

Stop your activity and rest.
Take your nitroglycerin medicine.
Take another dose after 5 minutes if the first dose does not relieve the symptoms.
Call for an ambulance if you still have symptoms 5 minutes after the second dose is taken.

Angina Treatment Options

The treatment and management of angina depend on the type of angina you have.

Lifestyle modification

If your angina is stable, you may be able to control it by adopting a healthy lifestyle and taking medications.

Medications

Nitroglycerine may be prescribed for quick pain relief or prevention of chest pain associated with angina. Your doctor will also provide instructions on when and how to take nitroglycerine. If you are prescribed with sublingual nitroglycerine, ensure you always have a new, sealed supply with you. Store the tablets in their original container away from heat, light, and air. Refill your prescription every 3-6 months to avoid using outdated tablets.

Other medications prescribed for long-term angina management include anticoagulants, antiplatelets, beta-blockers, calcium channel blockers, and statins.

Surgical intervention

One of the following types of surgeries may be recommended if medications fail to effectively manage the angina.

Coronary angioplasty and stent insertion:A catheter is inserted into a narrowed or blocked coronary artery where a special balloon is gently inflated to widen the affected artery. In modern angioplasty procedures, a common practice involves the insertion of a small wire mesh tube, known as a stent, into the artery as part of the process. This stent remains permanently, facilitating improved blood flow within the artery.

Coronary artery bypass graft (CABG): This surgery involves creating an alternative pathway for blood flow around narrowed or blocked sections of major arteries to enhance the delivery of oxygen-rich blood to the heart.

Book an Appointment at Gleneagles Hospitals

If you are experiencing symptoms of angina that are worsening, do get in touch with us to book an appointment today for a consultation with the experienced team of Cardiologists at your nearest Gleneagles Hospital to receive the best possible care.

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